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Predictive risk factors of steroid dependent nephrotic syndrome in children
Maher Ahmed Abdel-Hafez1, Nagy Mohamed Abou-El-Hana1, Adel Ali Erfan1
1Pediatric Department, Faculty of Medicine, Tanta University, Egypt.
Insights
Predicting steroid dependency in children with nephrotic syndrome is crucial. Early indicators include cumulative steroid dose within six months and time to initial remission, aiding treatment strategies.
Area of Science:
- Pediatric Nephrology
- Clinical Pediatrics
Background:
- Steroid dependency poses challenges in managing childhood idiopathic nephrotic syndrome, increasing morbidity and treatment costs.
- Early prediction of steroid dependency can guide parental counseling and refine treatment strategies for pediatric nephrotic syndrome.
Purpose of the Study:
- To identify early clinical predictors of steroid dependency in children with steroid-sensitive nephrotic syndrome (SSNS).
- To aid in the early management of SSNS by identifying risk factors for steroid dependency.
Main Methods:
- Retrospective analysis of 52 children (ages 3-16) diagnosed with SSNS.
- Patients were categorized into two groups: steroid-dependent/frequent relapsers (n=24) and complete remission/recurrent (n=28).
Main Results:
- Children needing >140 mg/kg cumulative steroid dose in the first 6 months are at high risk for requiring steroid-sparing agents.
- Failure to achieve remission by day 20 of initial prednisone treatment predicted steroid dependency with 96% specificity.
- Relapses in steroid-dependent children were significantly associated with upper respiratory tract infections.
Conclusions:
- Cumulative steroid dose within the initial six months is a key predictor of steroid dependency in pediatric nephrotic syndrome.
- The duration to achieve initial remission (over 20 days) is another significant factor in predicting steroid dependency.
Background:
Development of steroid dependency is one of the difficult problems in the management of children with idiopathic nephrotic syndrome, leading to increased morbidity, complications and cost of treatment. Thus, predicting early in the disease course will be useful in counseling parents and may improve treatment strategy.
Objectives:
To determine the clinical characteristics that can predict the development of steroid dependency early in the initial episodes of steroid sensitive nephrotic syndrome (SSNS).
Patients And Methods:
The study included 52 children with SSNS. Their ages ranged from 3 to 16 years. Patients were divided into two groups. Group A consisted of 24 patients with steroid dependency or frequent relapses nephrotic syndrome and group B consisted of 28 patients with complete remission or recurrent nephrotic syndrome. Data obtained retrospectively from patients' files.
Results:
Children who require a cumulative steroid dose equal or more than 140 mg/kg to maintain remission during the first 6 months of the disease are at high risk to require steroid sparing agents (SSA) for disease control, and who did not achieve remission by day 20 of the initial prednisone course became steroid dependent with 96% specificity but with low sensitivity (50%). All steroid dependent children in this study showed relapses associated significantly with upper respiratory tract infections.
Conclusions:
Cumulative steroid dose in the first 6 months of treatment and the need of more than 20 days to achieve initial remission can predict steroid dependency in children with nephrotic syndrome.
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